By December 2002, the CDC estimated 6,924 Asians and Pacific Islanders (APIs) had been diagnosed with AIDS in the United States, representing 0.8% of 886,575 total AIDS cases. APIs made up 0.4% of the estimated 312,133 HIV/AIDS cases reported in 30 U.S. areas with confidential name-based HIV reporting. APIs represent almost 4% of the total U.S. population. Although APIs represent a small proportion of all reported HIV/AIDS cases, APIs may be underreported due to several factors. APIs are often misclassified as other races in medical records and HIV surveillance. National HIV (treating HIV infection when used along with other medicines) reporting data for the most recent period available did not yet include areas with large numbers of APIs, including the entire West Coast and New York City. Also, an underlying social stigma against discussing sexuality and drug use among API cultures may prevent many from testing for HIV Finally, APIs are underrepresented among patients at facilities where HIV testing occurs, indicating that APIs may not be tested as often as other racial/ethnic groups.
Although national data suggest APIs are at a lower risk for HIV infection (treating HIV infection) than whites and other persons of color, several API-specific studies indicate that APIs are just as likely as other racial groups, and in some cases more likely, to engage in unsafe sexual behavior and drug use that increase HIV risk. Other studies indicate that drug and alcohol use among APIs, as with other groups, is associated with reduced condom use and a higher number of non-primary partners. However, little research has been done to understand predictors of risk or testing practices of APIs in the United States.
The CDC, in collaboration with the University of California, San Francisco, developed and coordinated the anonymous HIV Testing Survey (HITS) to assess barriers to testing and the effects of surveillance policies on HIV testing. Public Health-Seattle & King County (PHSKC) conducted HITS in 2000. APIs make up the largest nonwhite group in King County but accounted for only 9% of the total number of interviews in 2000. The goals of HITS-API, which was conducted from June 2002 through June 2003, were to survey APIs at high risk of HIV to find barriers to HIV testing, measure knowledge of HIV surveillance policies and their impact on testing, and describe HIV risk (treating HIV infection when used in combination with other medicines) behaviors among APIs.